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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
540408854
Report Date:
11/01/2023
Date Signed:
11/07/2023 10:04:43 AM
Document Has Been Signed on
11/07/2023 10:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC
,
1314 E SHAW AVE
FRESNO
,
CA
93710
FACILITY NAME:
ACACIA HOME
FACILITY NUMBER:
540408854
ADMINISTRATOR:
MARTINEZ, DALE JR.
FACILITY TYPE:
735
ADDRESS:
783 ACACIA AVE
TELEPHONE:
(559) 638-6457
CITY:
REEDLEY
STATE:
CA
ZIP CODE:
93654
CAPACITY:
6
CENSUS:
DATE:
11/01/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:05 PM
MET WITH:
TIME COMPLETED:
02:29 PM
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Visit attempted. Phone call to Administrator, Dale Martinez at number on file and facility phone. Messages left with no return call.
SUPERVISORS NAME
:
See Moua
LICENSING EVALUATOR NAME
:
Mary Garza
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/01/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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